Investigations and Initial Management
Bloods on admission were unremarkable other than an acute kidney injury
with a creatinine of 136µmol/L from a baseline of 68µmol/L. Computerised
tomography of his abdomen and pelvis with intravenous contrast showed
herniation of several bowel loops, the prostate gland and the entire
bladder into the right hemiscrotum causing obstructive uropathy (see
figure). He was catheterised with some difficulty and had a residual
volume of 2000ml. Following discussion with the patient and his family
regarding definitive management of the hernia, a joint decision was made
to treat conservatively. He remained clinically stable and was
subsequently discharged home with long-term catheter in situ.